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Reflective Practice

Business man and woman at a table with papersHome visiting is relationship-based work. There are few right answers in home visiting, and relationships can ebb and flow. Reflection, "stepping back from the immediate experience to sort through thoughts and feelings about what one is observing and doing with children and families"i  is a crucial practice for home visitors. It helps you understand what you see, how you plan with families, and how you take care of yourself and the important relationships you build in your work during the course of home visits.

In the home-based model, reflective practices occur on three levels.

  • Reflecting with the parents about their own experiences and how they understand their child's experience
  • Reflecting on your own practice
    • Supervisors and home visitors engage in reflective supervision as a way to process and plan for the work
  • Reflecting with parents and providing them with a way to talk about what they observe in their children and how they are feeling. This also provides an opportunity for parents to honestly discuss their thoughts about how it feels to work with you, the home visitor
    • Talk with families about daily routines and experiences you suggest and how they see their children responding
    • Reflecting can generate ideas for expanding successful efforts, clarifying misunderstandings, and imagining different ways to approach moments that did not work out well
    • Families should be encouraged to share their reflections on working with you

Reflection is an activity that takes time and should be built into the home visitor's schedule. Programs may encourage their home visitors to use journaling for reflection, to have home visitors meet in groups to reflect as peers, or to use reflective supervision. This also provides an opportunity for parents to honestly discuss their thoughts about how it feels to work with you, the home visitor.

How To

You can reflect with parents by:

  • Identifying a situation that deserves notice. It may be very positive; for example, immediately after the baby rolls over, he looks at his dad with a smile. Or it may be something less pleasant to address, such as a parent who says, "She's such a show-off. What a pest."
    • You might say, "What is it like to have him look at you as if he's saying, ‘Look what I did, Daddy?' You sure are important to him." Or, "I wonder what it feels like to you when you think she's showing off? What is she pestering you for? It sounds like ‘showing off' is not a very good thing. Can you tell me more about that?"
    • It could be tempting to say, "She's not showing off; she just wants you to be proud of what she can do," but that would show a lack of empathy for something the parent is really trying to tell you.
      • Head Start and Early Head Start are programs that serve both child development and the development of effective parenting. For children to thrive, they need parents who are invested and engaged in the process. Parents need to be heard.

You can help parents be reflective by:

  • Inviting them to offer their observations first (e.g., "Let's watch Cade cruising on that couch. What does that tell you about her right now?")
  • Helping the parent reflect on the meaning of their child's actions; for example:
    • "Do you notice how often he looks at you and watches you? Right now he wants to learn everything from you. When you respond and keep the play going, you're really helping him to stay with something and keep learning from it."
    • "She's working so hard for you to notice what she's doing. What do you think about that? Are there some things you enjoy doing with her?"
  • Providing parents of children with disabilities and special health needs with sensitive support as they respond to those challenges

You can reflect on your own practices in the following ways.

Reflecting on the Visit

  • Dedicate time. You are busy! However, reflection is such an important part of what you do; it is helpful to schedule time to reflect.
    • Plan it for a time soon after the home visit so you can remember as much as possible.
  • Reflect on your own responses to the visit.
    • Did it feel productive?
    • Were the parents and child comfortable and engaged?
    • Was there anything of concern you needed to address—or wished you had addressed?
  • Consider family feedback on the visit.
    • It can be helpful to set aside a few minutes for reflection at the very end of the visit. Some programs ask for parent feedback in writing. Sometimes, home visitors set aside time at the beginning of a visit to reflect on what happened the previous week. This can be a reflection on last week's visit or just a check-in about how families used last week's visit to move forward toward their goals.
      • How are family reflections similar to yours? How are they different?
  • Be aware of the quality of relationship and the boundaries between the parents and yourself.
    • Too much distance may make the experience feel clinical and official to the parents. They may feel as though you are in charge. However, not maintaining some professional boundaries (e.g., talking about your personal life) can blur the lines between a professional relationship and a friendship. A friend can do things with or for a parent that you can't or shouldn't do in your role.
  • Review whether:
    • The experiences of the visit followed the child's goals and interests
    • The parents had most of the interaction with the child
    • You helped the parents notice the link between their actions and their child's response
    • The family recognized the ways in which they promoted their child's learning in the visit
  • Review the joint planning experience.
    • How did the parents' observations and ideas drive planning?
    • How did you bring in information from the assessment, the curriculum, and your own knowledge of the family's interests, routines, and resources?
  • Consider whether this home visit was really individualized.
    • Were you flexible and able to make changes if the parents or child were not engaged?
    • How was it different from what you would have done at any other home visit?

Working with Your Supervisor

  • Use reflective supervision.
    • Reflective supervision is a mutual process of exploring your work with families, sharing your understanding of each family, examining your own feelings and experiences, and developing ideas together about how you will proceed.
    • Supervisors do not have all of the answers, nor should they be expected to answer all of your questions or concerns; what's really nice is when the two of you can discover, develop, and create responsive strategies for working with families together.
  • Recognize that you cannot do this alone. Home visiting can be very isolating. Look for opportunities to talk to colleagues about your work.
  • Set an agenda.
    • Make sure that you talk about the events and issues that are most important by developing your agenda ahead of time.
    • List out what you want to discuss and, if possible, send it to your supervisor before you meet.
  • Use the services of the mental health consultant.
    • If you don't have regular opportunities to talk with your supervisor, learn whether you can approach the mental health consultant.
    • Often, their expertise can support you with the most difficult issues that you are facing.
  • Prioritize supervision.
  • Be as open and honest as possible.
    • It often takes time to build a sense of safety with your supervisor, but there is no such thing as a perfect home visitor—or even a perfect home visit!
    • By sharing mistakes, challenges, and questions, home visitors can make the most of this time.

Experience It

In this video clip, a home visitor participates in a role play about the challenge of a family not showing up for home visits. As the supervisor in the mock reflective supervision session, early childhood expert Rebecca Shahmoon-Shanok, LCSW, Ph.D, provides feedback to the home visitor. In addition to the guidance in this particular scenario, the home visitor learns that she operates within the context of a team and must rely on them at times for advice and resources.  

Voices from the Field: Home Visitor and Supervisor Video 1

Download the video [MP4, 38MB] Download the transcript
View the transcript

Open Doors

Chapter 11c: Reflective Practice Experience It

Lillian Sugarman: There was a second role play that Rebecca and her group did about a home visitor who had a mom who wouldn't consistently let her in the door. The home visitor was venting about this experience with Rebecca as her reflective supervisor, and Rebecca validated her feelings of frustration and used a role-reversal strategy to help the home visitor problem-solve how she might address the situation. The group went through this exercise and then talked about it. So let's take a look at this. 

Rebecca: You're coming with one agenda. 

Kia: Mm-hmm.

Rebecca: She wants some relief.

Kia: Mm-hmm.

Rebecca: So, we have to find a bridge from where she is to where you are, and that bridge may take some time.

Kia: Yeah.

Rebecca: What do you say when you call?

Kia: I say, "Hello, this is your home visitor. We have an appointment scheduled for tomorrow. Will you be available?"

Rebecca: And then I'd say, "Yeah, I'm going to be home."

Kia: Yes. 

Rebecca: "Where else am I going to go?"

Kia: Right. If she picks up, she says, "Yeah, so I'll be here." And if she doesn't pick up, then of course I leave a message similar to that and ask her if she will call me back. 

Rebecca: Okay, so let's take a deep breath. I'd like you to pretend that you are her, and I'm going to be you for a minute, and I'm going to make that phone call. I'm going to try to pretend to be you. 

Kia: Okay. 

Rebecca: Okay. And I'd like you then to hear it and tell me what I could have said on the phone that might get you to open the door. I want you to hear me from a critical point of view. 

Kia: Okay.

Rebecca: Okay. Hello, Jennifer?

Kia: Hi.

Rebecca: Hi. This is your home visitor, and I just want you to know that we have an appointment. I want to remind you that we have an appointment tomorrow at 2:00. Are you going to be home? 

Kia: Yes, I'll be home.

Rebecca: Okay. So I'll see you around 2:00 then.

Kia: Okay.

Rebecca: Okay. Thanks a lot.

Kia: All right. Bye.

Rebecca: Bye-bye.

Rebecca: How do you feel?

Kia: It's kind of funny. It's kind of like you're just calling me, because you have to. You're just coming to the house because you have to, not because you want to see me and you want to spend time with my children. You were just doing your scheduled visit like you do with everybody else that you have to interact with.

Rebecca: Is that true about why you want to go?

Kia: No, not at all.

Rebecca: What's true?

Kia: The truth is I really care about this family, and I really am deeply concerned.

Rebecca: Okay. So there's -- we're identifying something really important, that there is a gap between what you feel and intend and what she's likely to be understanding. So, we need to build a bridge. We can't change her right now. 

Kia: Right.

Rebecca: So, I'm going to call you up again. And you're Jennifer, and I'm going to say... Okay. Okay, so... Hello, Jennifer? Kia: Hello.

Rebecca: Hi. This is Rebecca.

Kia: Hi, Rebecca. How are you?

Rebecca: Hi. I'm well. I've been thinking about you.

Kia: Oh, really?

Rebecca: Yeah. How are you doing?

Kia: Oh, I'm good.

Rebecca: Yeah?

Kia: Yeah, I'm doing well.

Rebecca: I was thinking about you and how hard you're working and I'm calling to just let you know that we have an appointment tomorrow, and I'm wondering if that's convenient for you. 

Kia: Tomorrow's not really convenient. I don't -- I don't think I can make the appointment tomorrow.

Rebecca: Uh-huh. What would be better for you?

Kia: Can we reschedule maybe for later on in the week?

Rebecca: Mm-hmm. Hang on. Let me just look at my calendar.

Kia: Okay.

Rebecca: Could Friday work?

Kia: Yes, I think Friday could work.

Rebecca: Around what time would work?

Kia: Could you come around, 11:00?

Rebecca: Mm, I can't do 11:00, but I could do 1:00.

Kia: Okay. Okay.

Rebecca: That would be okay?

Kia: Mm-hmm.

Rebecca: Okay. Is there anything I could pick up for you on the way?

KIA: Oh, um, no, no, there's nothing I need at the moment, but thank you for asking.

Rebecca: You're welcome. Okay, would you like me to call and remind you, or you think you'll remember?

Kia: I'll remember.

Rebecca: Okay. All right, then. See you on Friday.

Kia: Thank you.

Rebecca: Bye.

Kia: Bye.

Rebecca: So, how did that feel?

Kia: It felt like you actually cared about what was, one, convenient for me, two, how I was feeling, and then you went the next step and actually asked if I needed something.

Close

Kraig Gratke, a program director, talks about how his program uses reflective practice to support his staff. The program has made a number of changes recently to better serve its home visitors and families. Staff works jointly throughout the process of working with families to support each other and provide needed resources and information. The home visitors work in teams and share offices, and the supervisor-staff ratio has been reduced. Reflective supervision is critical to supporting staff and the process pervades the program.

Voices from the Field: Home Visitor and Supervisor Video 2

Download the video [MP4, 41MB] Download the transcript
View the transcript

Open Doors

Chapter 11b: Reflective Practice Experience It

Kraig: I would say that we have built a system around home visitors to be very supportive. In the last couple of years, particularly since ARRA, we have reduced our supervisor-to-staff ratio. Before, it was me and one other person for 12 people. Now, the ratio is about one supervisor for four. We've also spent a lot of time building teams, so that they can talk to each other and put them in offices together and said, "You have to have office time and access your supervisor." The other part of that is we've built a management team that's very responsive.

I'm available from an administrative perspective, but we also have health staff that are available and social work staff that are available and mental health staff and nutrition staff, so if they have questions that -- and that's the other thing we've been very honest about is if you don't know the answer then don't make anything up. [Chuckles] You know, be honest and call and tell the parents you don't know the answer and find the answer, and if that's us, then that's us, but then find the answer you can get back to them. So, we've built in a lot of that kind of very basic support, but I think the families or home visitors dealing with, you know, we've got a pregnant mom and she's spotting, then, that's something that needs to be dealt with now, and we have somebody that right then can deal with that and can make a call and say, "Yeah, this is what needs to happen." And home visitors have gotten comfortable now in resourcing that and have learned, you know.

For new home visitors, it's very good to have that. The older ones now understand that, okay, if this is what's happening, this is my recommendation, this is what I need to do. And so, it's kind of a capacity building all the way up from, you know, new employees that are coming in that don't have a lot of skills, all the way up to, you know, the management level being able to articulate and get that information out.

I think some of the things that the home visitors face today are very different. 

We have home visitors that have exposure to violence. We have home visitors that are exposed to substance use and home visitors that have to deal with some significant mental health issues. And some of that is working with the courts, and some of that is reporting and, you know, maltreatment of minors and neglect, minors and neglect, and they deal with issues of children that are not developing for a lot of different reasons, and mostly it's environmental. You know, and we routinely have those discussions with families. You know, if there's not food in the house and the child isn't growing, we have people that are looking in cupboards and saying, "Okay, what's going on here? We need to address this."

You know, and the same can be said for moms that moms or dads -- and that's the other piece, is there are dads I mean, we have dads in the program we try to include them, but if we're in a house and there's domestic violence and it's you can see it and it's going on, there's referrals, and things have to happen. Sometimes, that happens on the walk out to the car, because you don't want to do that in front of other people. You know, and substance use is the same thing if you're in a house and you're smelling things or you're seeing things, those are things that we report and have to deal with. And, of course, all of that is done up front.

You know, parents know that we're reporting that we have to report, and I make that very clear to staff that this is part of your job, and you don't want to lose your job, because you didn't do something because you didn't do something and, you know, it's somebody else's job to figure out what  that is, you know. I can talk about teen moms and we have teen moms that really love their kids, they don't have any idea what parenting is or how to raise children and those are things that you really have to spend time with, so much so that you have to, you know talk about changing diapers. It's an importa -- I mean, very basic kinds of things that, you know, most folks won't even think about, but it's like, "Okay, it's time." It's not how to change, but it's time, and it's time to give a bath and it's time to feed so it's very basic things. And we've started building in supports around mental health for that.

You know, part of that is we've done training around DC Zero to Three and recognizing -- staff recognizing that children that are not sleeping, that are not sleeping with any amount of time that have eating issues, have elimination issues all of those things in infants and toddlers can be clues to a lot of serious kind of issues that are in the house and issues that, you know if you've worked with parents you can deal with some of those things, before they become bigger things you know, bigger problems.

Close

Learn More

Reflective Supervision
Reflective supervision is a process through which supervisors and direct service staff work together to understand the children and families that they serve, as well as their own feelings about this often emotionally difficult work. This paper provides directors, administrators, and staff with a tool for relationship-based Early Head Start services and describes how some programs have implemented reflective supervision.

Parent, Family, and Community Engagement Simulation Series: Boosting School Readiness through Effective Family Engagement
What you do and say matters! Explore and practice everyday strategies for developing a positive, goal-directed relationship with a family. The modules begin with an intake visit in a virtual Head Start Center and continue into home visits with the family. Relationships are key to our work with children and families, including the journey toward school readiness.

Family Connections: A Mental Health Consultation Model
Explore Family Connections, a preventive, system-wide mental health consultation and training approach to strengthen the capacity of Head Start and Early Head Start staff. Use these resources in engaging and supporting families dealing with parental depression and related adversities and working with children in classrooms and in the home. These materials were developed by the Family Connections Project at Boston Children's Hospital.

i Shahmoon-Shanok, R., Gilkerson, L., Eggbeer, L., and Fenichel, E. “Reflective Supervision: A Relationship for Learning.” A Training videotape, discussion guide, and sourcebook. Zero to Three. Washington, DC, 1995. 

Read more:

,  Family Engagement